The overuse of scans has been the subject of growing concern in recent years, but a review of the federal data, focusing on a common procedure performed millions of times a year, offers a rare and detailed snapshot of the problem state by state, hospital by hospital.
In 2008, about 75,000 patients received double scans, one using iodine contrast to check blood flow, and one that did not. “If you do both, you bill for both,” said Dr. Michael J. Pentecost, a radiologist and Medicare consultant.
Radiologists say one scan or the other is needed depending on the patient’s condition, but rarely both. Double scanning is also common among privately insured patients who tend to be younger.
Double scans expose patients to extra radiation while heaping millions of dollars in extra costs on an already overburdened Medicare program. A single CT scan of the chest is equal to about 350 standard chest X-rays, so two scans are twice that amount.
“The primary concern relates to radiation exposure,” said Dr. James A. Brink, chief of diagnostic radiology at Yale-New Haven Hospital, where double scans accounted for only a fraction of 1 percent of cases. He added: “It is incumbent upon all of us to limit it to the amount needed to make a diagnosis.”
Officials at hospitals with high scan rates said radiologists ordered the extra chest scan figuring that more information is better. In rare instances, the two scans might help a doctor distinguish between tangled blood vessels and a tumor, Dr. Pentecost said.
Double scanning is more likely to occur at smaller, community hospitals such as Memorial Medical Center of West Michigan in Ludington. It gave two scans to 89 percent of its Medicare chest patients..
A few large hospitals have had problems as well. St. John Health System in Tulsa double-scanned 80 percent — or 800 of its Medicare outpatients in 2008. “We recognized in late 2008 and early 2009 those numbers were higher than we needed to be,” said Charles Anderson, the hospital’s president and chief executive.
UNC Healthcare in Chapel Hill, N.C., performed nearly 2,000 scans in 2008 and none were doubles. “I would be very surprised as to why that would occur,” said Dr. Paul L. Molina, the hospital’s executive vice chairman of radiology. “Someone’s got to educate me as to why they see the need to do both.”
The Medicare agency believes hospitals can and should do more to change physician behavior. “Hospitals will say, ‘Wait, we don’t order tests, why are you measuring us?’ ” said Dr. Michael Rapp, who directs the Quality Measurement and Health Assessment Group for the federal agency. But, he added, “Hospitals certainly have the ability to put in policies and to monitor what’s happening.”
The federal agency plans to use other, similar measurements to rein in what it considers to be unjustified — and potentially dangerous — medical procedures.